Restless leg syndrome is a sleep disorder characterized by leg discomfort during sleep, which is only relieved by frequent movements of the legs.
Nocturnal myoclonus; RLS
Causes, incidence, and risk factors:
Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. It is worsened by stress. The cause is not known. RLS may occur more often in patients with peripheral neuropathy, chronic kidney disease, Parkinson's disease, pregnancy, iron deficiency, or the use of certain medications. A hereditary form also exists, and may be a factor when symptoms start at a younger age. The abnormal gene has yet to be identified.
Restless leg syndrome can result in a decreased quality of sleep (insomnia ) with subsequent daytime sleepiness , anxiety or depression, and confusion or slowed thought processes from lack of sleep.
The disorder consists of sensations in the lower legs that make the person uncomfortable unless the legs are moved. The sensations usually occur shortly after going to bed but may also occur during the daytime.
The abnormal sensations occasionally occur in the upper leg, the feet, or the arms, in addition to the lower leg.
There is an irresistible urge to walk or move the legs to relieve the discomfort, resulting in periodic episodes of leg movements during early sleep stages. Symptoms, which may last for 1 hour or longer, can include:
- Abnormal sensation in the legs (occasionally, feet, thighs, arms)
- Creeping sensations or discomfort (not pain, not cramps) relieved by movement of the legs
- May occur during the day
- Worse when lying down
- Irresistible urge to move the legs
- Persistent leg movements during sleep hours
- Sleeping difficulty
Note: Symptoms may be worse during stress or emotional upset.
Signs and tests:
There is no specific examination for restless leg syndrome. No structural or other abnormalities are usually discovered unless peripheral nerve disease is also present. Blood tests (CBC and serum ferritin ) may be done to rule out iron deficiency anemia , which rarely has been associated with restless leg syndrome.
Examination and testing may be used to rule out other disorders that may cause similar symptoms, especially disorders associated with ischemic claudication of the legs.
There is no known cure for restless leg syndrome.
Treatment is aimed at reducing stress and helping the muscles relax. Warm baths, gentle stretching exercises, massage or similar techniques may help.
Low doses of pramipexole or ropinirole (Requip) have been found to be very effective in controlling symptoms in some people. If sleep is severely disrupted, medications such as Sinemet (an anti-Parkinson's medication), gabapentin and pregabalin, or tranquilizers such as clonazepam may be prescribed, but they may cause daytime sleepiness.
Patients with iron deficiency will receive iron supplements.
Low doses of narcotics may sometimes relieve symptoms of restless leg syndrome.
Restless leg syndrome is not dangerous or life-threatening and does not indicate a serious disorder. It can be uncomfortable and can disrupt sleep.
Insomnia may occur.
Calling your health care provider:
Call for an appointment with your health care provider if symptoms of restless leg syndrome are present and sleep is disrupted.
Techniques to promote muscle relaxation and stress reduction may reduce the incidence of restless leg syndrome in people prone to the condition.
Bayard M, Avonda T, Wadzinski J., Am Fam Physician. 2008 Jul 15;78(2):243
Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007
Kushida CA. Clinical presentation, diagnosis, and quality of life issues in restless legs syndrome. Am J Med. January 2007;120(1 Suppl 1):S4-S12.